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Reading of the Week: Antipsychotics – Good for Work Ability? Also, Mental Health Research Funding (CJP) and Murdoch on Her Career (CBC)

January 19, 2023 /

From the Editor

As clinicians, we often think about symptoms and symptom scales – important measures of a patient’s journey. Patients may focus on other things, like functionality, including employment.

Do antipsychotics help those with psychosis for their ability to work? Do some antipsychotics provide more advantage than others? Dr. Marco Solmi (of the University of Ottawa) and his co-authors try to answer these questions in a new American Journal of Psychiatry paper. They draw on Swedish databases involving more 21,000 people. They conclude: “Among individuals with first-episode nonaffective psychosis, antipsychotic treatment (with long-acting injectables in particular) was associated with about 30%–50% lower risk of work disability compared with nonuse of antipsychotics in the same individuals, which held true beyond 5 years after first diagnosis.” We consider the paper and its clinical implications.

In the second selection, Florence Dzierszinski (of the University of Ottawa) and her co-authors look at mental health research funding in Canada. In a Commentary for The Canadian Journal of Psychiatry, they argue that funding is lacking and, in fact, declining. They write that: “Adequate research funding could go a long way to addressing prevention, care, and treatment for the one in four Canadians who experience mental health problems in a given year, improving outcomes for individuals and for Canada’s society and economy.”

And in the third selection, published by CBC First Person, Darleen Murdoch talks about her career and retirement – and her diagnosis. She notes that, during her first hospitalization decades before, she was told by her physician she would never work. She writes: “In my own way, I have proven to the medical field that ‘miracles’ can happen.”

DG

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Reading of the Week: The Best of 2022

January 12, 2023 /

From the Editor

Welcome 2023.

It’s our tradition that we begin the New Year by reviewing the best of the past year; so, this week, we look back at 2022.

But a bit of a break from tradition: this year, we haven’t organized the papers by different categories, instead choosing eight great papers. Some have been published in big journals; others, not so big. They cover a variety of topics, from prevention to cutting-edge treatments. The one common thread: all are clinically relevant. And, yes, there is a Person of the Year. Spoiler alert: he had a big career and likes to mention Groucho Marx.

An observation about this past year: the quality of scholarship was very high. We’ve picked good papers – but could have picked scores of others. It’s a comment we’ve made in past years, and a good reason for optimism as our field grows more sophisticated and relevant.

DG

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Reading of the Week: PTSD & Healthcare Workers – the New Lancet Psych Paper; Also, Social Media and Youth (Aust Psych) and BMJ’s Xmas Call to Action

December 22, 2022 /

From the Editor

We talk about the virus’ effects on our patients, both in terms of physical and mental health. But what has it done to us?

Health-care workers have been on the front lines of this pandemic and have experienced the psychological toll. While past studies have considered mental disorders of health-care workers, their methodology hasn’t been strong, often relying on online surveys. In the first selection, Hannah Scott (of King’s College London) and her co-authors look at mental disorders and the pandemic in a new Lancet Psychiatry paper. Importantly, they did a two-phase, cross-sectional study comprising of diagnostic interviews. They write: “The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools.” Still, they found that about one in five met threshold for a mental disorder and “thus might benefit from clinical intervention.” We consider the paper and its implications.

In the second selection, Beatrice Webb (of Flinders University) and her co-authors look at social media and young people. In a Point of View paper for Australasian Psychiatry, they note problems with mental health including the rise in psychological distress – something tied to social media. They also observe some benefits to Instagram and other online platforms. The paper is practical and offers advice, including: “We encourage clinicians to explore social media use in the assessment of young people, due to potential impacts on depression, anxiety and self-harm.”

At this time of year, The BMJ runs its Christmas issue, meant to be light-hearted and with liberal use of British humour. In the third selection, Ryan Essex (of the University of Greenwich) considers calls to action in the medical literature. In an Editorial, he opines: “The call to action has several obvious advantages over actually acting. Making that call allows you to salve your conscience, to ‘do something’ without the hard work of actually doing something.”

There will be no Readings for the next two weeks. We will return with force (but a lack of British humour) on 12 January 2023 when we will review the best papers of the year. A quick word of thanks for your continuing interest.

All the best in the holiday season.

DG

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Reading of the Week: Can a Phone Intervention Reduce Alcohol? Also, Dr. Goldbloom on His Career & Retirement (QT) and Ending the Term AMA (Annals)

December 15, 2022 /

From the Editor

During the first wave, alone and isolated, he started to drink significantly more. Now, many months later, he continues to struggle with an alcohol use disorder. This patient’s journey – as he told me in the ED last week – is a familiar story that we as clinicians have heard many times in these past few years. What can be done to help? Could we better reach those who are misusing alcohol?

In JAMA Psychiatry, Dan I. Lubman (of Monash University) and his co-authors describe an intervention that is very relevant. In this Australian RCT, some participants received 4-6 sessions of telephone-provided, manualized cognitive and behavioural intervention that included mindfulness. They found that: “this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control.” We discuss the paper and its clinical implications.

Dr. David Goldbloom has had a storied career: senior medical advisor at CAMH, professor at the University of Toronto, former chair of the Mental Health Commission of Canada, former editor of The Canadian Journal of Psychiatry. And tomorrow, he adds another title to that long list: retiree. This week’s second selection is a new Quick Takes podcast interview with him in which he comments on career and retirement and more. “I’m not an entirely gloomy or nihilistic person, either by temperament or based on what I’ve witnessed over the last 40 years.”

Finally, in the third selection, Dr. Robert A. Kleinman (of the University of Toronto) and his co-authors argue that “against medical advice” is a dated term. In Annals of Internal of Medicine, they argue for a new approach: “Shifting away from the ‘AMA’ terminology and toward more collaborative approaches to these discharges would improve the treatment of patients who are too often stigmatized by the clinicians and health systems that are meant to care for them.”

DG

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Reading of the Week: Virtual Care & Schizophrenia – the New CJP Paper; Also, the Psychedelic Hype Bubble (JAMA Psych) and Aiello on Stigma (Walrus)

December 8, 2022 /

From the Editor 

At the start of the pandemic, the shift to virtual care was important and necessary, allowing us to reach our patients during the lockdowns. As we slowly move past COVID-19, there are big questions to ask. What’s lost in the virtual world? What’s right and what’s to be done?

In the first selection, Ellen Stephenson (of the University of Toronto) and her co-authors look at patients with schizophrenia. In a new paper just published in The Canadian Journal of Psychiatry, they analyze different aspects of care, including prevention. They find: “There were substantial decreases in preventive care after the onset of the pandemic, although primary care access was largely maintained through virtual care.” We consider the paper and its clinical implications.

Virtual care, real-world gaps?

In the second selection, David B. Yaden (of Johns Hopkins University) and his co-authors weigh in on the enthusiasm and criticism of psychedelics. In this Viewpoint for JAMA Psychiatry, they argue that interest has reached a “hype bubble.” They make a call for action: “As scientists and clinicians, we have an ethical mandate to dispute claims not supported by available evidence. We encourage our colleagues to help deflate the psychedelic hype bubble in a measured way…”

And in the third selection, K. J. Aiello – who has lived experience – writes about mental illness and stigma in an essay for The Walrus. While noting some progress in the acceptance of mental disorders, the writer wonders how much has really changed. “Even as the stigma around mental illness has faded, it has become clear that this compassion and effort extend only so far, and that they are not available to everyone. Often those fault lines appear around class – and around the type of mental illness.”

DG

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Reading of the Week: Smoking Cessation – Doing Bad, Feeling Good? Also, Ethnicity & Opioids (JAMA Psych) and Dr. Freedman on Lunches (Acad Psych)

December 1, 2022 /

From the Editor

We ask our patients about cannabis. We inquire about illicit drugs. But are we forgetting tobacco? A new paper in Psychiatric Services helps answer that question – and, perhaps, raises other questions, including about how we could do better. 

In the first selection, Sarah A. White (of Johns Hopkins University) and her co-authors draw on American data to look at smoking cessation medications in a new Psychiatric Services paper. Among more than 55,000 smokers (many of whom have mental illness), they find that: “Cessation pharmacotherapy for smokers remained vastly underprescribed across all groups. At least 83% of smokers with or without mental illness did not receive varenicline, NRT, or bupropion during the 14-year study period.” We consider the paper and its clinical implications.

In the second selection, Huiru Dong (of Harvard University) and her co-authors look at buprenorphine treatment and demographics in the United States. Their JAMA Psychiatry research letter, which was just published, finds a growing gap. “The observed heterogeneity in buprenorphine treatment duration among racial and ethnic groups may reflect disproportionate structural barriers in treatment retention for Opioid Use Disorder.”

In the third selection, Dr. David Freedman (of the University of Toronto) writes about resident lunches for Academic Psychiatry. Dr. Freedman, who is a resident, notes that in-person lunches shifted to virtual ones for more than two years because of the pandemic – something that was necessary but unfortunate. He argues that the gatherings are important. “Yet, as a collective of residents munch on the last bites of their sandwiches, say goodbye, and return to work, I am struck by the camaraderie. Funded resident lunches nurture the professional identities of psychiatry trainees – an essential element of medical education.”

DG

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Reading of the Week: Mindfulness for Anxiety? The New JAMA Psychiatry Paper; Also, Sim in Med Ed (QT) and Dr. Sen on Burnout & Depression (NEJM)

November 24, 2022 /

From the Editor

Mindfulness is trendy. It’s offered at your local YMCA. There are mindfulness techniques in popular apps. Corporations offer sessions over the lunch hour.

But is it helpful? Millions of North Americans struggle with anxiety disorders. Could mindfulness help them? Is it an alternative for those who don’t want to take medications? In the first selection, Dr. Elizabeth A. Hoge (of Georgetown University) and her co-authors try to answer these questions. Their results have just been published in JAMA Psychiatry. In an RCT, they compare a form of mindfulness to the use of an SSRI. They write: “Our prospective randomized clinical trial found that MBSR was noninferior to escitalopram for the treatment of anxiety disorders.” We consider the paper and its clinical implications.

In this week’s second selection, we look at a new Quick Takes podcast interview with CAMH’s Stephanie Sliekers and Dr. Petal Abdool (of the University of Toronto). They discuss simulation in mental health education, noting the potential. They also talk about their innovative work in this area. “We can create an environment that’s safe, predictable, consistent, standardized, and reproducible.”

In this week’s third selection, Dr. Srijan Sen (of the University of Michigan) writes about physician burnout. In a Perspective paper published in The New England Journal of Medicine, he argues that separating burnout from depression is problematic. He writes: “Expanding reform efforts to encompass depression and mental health more broadly will not reduce the urgency of reforming our health care system. Rather, it will increase the likelihood that physicians who are struggling can access the spectrum of available evidence-based individual interventions.”

DG

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Reading of the Week: Psilocybin for Treatment-Refractory Depression – the New NEJM Paper

November 10, 2022 /

From the Editor

“Severe depression eased by single dose of synthetic ‘magic mushroom’”

– CNN, 3 November 2022

For its proponents, psilocybin could be the breakthrough we have been waiting for in depression treatment. For its critics, psilocybin lacks evidence.

What to make of psilocybin? Dr. Guy M. Goodwin (of the University of Oxford) and his co-authors attempt to answer that question with a phase 2 double blind trial focused on those with treatment-resistant depression, offering participants psilocybin at three different doses, in addition to therapy. The resulting paper was just published in The New England Journal of Medicine and has received much attention (including, yes, coverage by CNN). They find: “participants with treatment-resistant depression, psilocybin at a single dose of 25 mg, but not 10 mg, reduced depression scores significantly more than a 1-mg dose over a period of 3 weeks but was associated with adverse effects.” 

The future of depression treatment?

We discuss the big paper and the review the accompanying Editorial by Bertha K. Madras (of Harvard University). We also have comments from Dr. Ishrat Husain (of the University of Toronto), one of the study co-authors.

So does psilocybin offer a breakthrough? Read on and decide for yourself.

(Note that there will be no Reading next week.)

DG

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Reading of the Week: Are Involuntary Admissions on the Rise? The New CJP Paper; Also, Telepsychiatry (JAMA Psych) and Dr. Oh on Suicide (Acad Psych)

November 3, 2022 /

From the Editor

A recent New York Times article notes that adolescents are increasingly looking for information on mental health and turning to TikTok. Such is life at a time when stigma fades: people are curious, though not necessarily going to the best places for information.

But are we reaching people earlier in their illness experience? We hope that the answer is yes – a new paper with British Columbian data, however, suggests that police apprehensions are more common, as are involuntary admissions, indicating that more people are in crisis. In the first selection from The Canadian Journal of Psychiatry, Jackson P. Loyal (of Simon Fraser University) and his co-authors draw on administrative databases and find a major shift: “While roughly half of the people hospitalized for mental health and substance use disorders were admitted voluntarily in 2008/2009, by 2017/2018 this fell to approximately one-third.” We look at the paper and its clinical implications.

British Columbia: a province of rivers, whales, and involuntary admissions

In the second selection, Dr. Carlos Blanco (of the National Institute on Drug Abuse, United States) and his co-authors consider the rise of telepsychiatry, noting that 39% of mental health care in the US is now virtual. In this new JAMA Psychiatry Viewpoint, “Expansion of telepsychiatry creates new opportunities to increase treatment access, while it poses overlapping challenges to multiple stakeholders…”

And in the third selection, Dr. Nicholas Zhenwei Oh (of the Ministry of Health Holdings, Singapore) writes personally and thoughtfully about the loss of a patient by suicide. He goes into detail on his own experience during training. “Patient suicide is possibly the great equaliser amongst psychiatrists, psychiatry trainees, and perhaps any other clinician who has experienced a patient’s suicide. My own experience came suddenly and unexpectedly, and it will likely leave a psychological scar as a grim reminder of one of the lowest points of my career.”

DG

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Reading of the Week: Lithium & Renal Health – the New Lancet Psych Paper; Also, COVID & Suicides (ANZJP)

October 27, 2022 /

From the Editor

After starting lithium in the hospital, his life was transformed. My patient didn’t have another hospitalization, and he went back to excelling at his job and raising his young family.

There are many lithium success stories. But how safe is it for our patients’ kidneys? Though lithium has been used for decades, there is still controversy. We know that lithium can affect the kidneys, but how much renal change is naturally occurring (aging), due to psychiatric illnesses (like bipolar), or the medication itself?

In a new paper just published in The Lancet Psychiatry, Filip Fransson (of King’s College London) and his co-authors attempt to answer these questions with a cross-sectional cohort study drawing on 2,200 people from Sweden. They review kidney function over time for the general population, those with schizoaffective disorder and bipolar, and compare them to those on lithium. They find a significant connection between lithium and renal decline, but only after a decade of use. We consider the paper and its clinical implications.

In the second selection, Dr. Nick Glozier (of The University of Sydney) and his co-authors consider suicide rates during the pandemic in a new research article for the Australian & New Zealand Journal of Psychiatry. They note the dire predictions – of a “suicide epidemic” – that weren’t realized, and consider why, noting several factors, including that the economic downturn was mitigated by government action. Ultimately, though, they write: “suicide is an inherently difficult (stochastic) event to predict.”

DG

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